The decision by Pfizer to stop selling Exubera, its inhaled insulin product, made waves in the pharmaceutical industry primarily
because it is so unusual for a major pharmaceutical company to admit defeat. In Exubera's case, however, there seemed to be
little other choice. The market had spoken very clearly: physicians didn't like the product and neither did patients, put
off by concerns about potential side effects (slight reduction in lung function) and the bulkiness of the delivery device.
The market's rejection of Exubera didn't stop rampant speculation about successors to Exubera, however. The industry press
paid much attention to the prospects for the inhaled insulin product being developed by the partnership of Eli Lilly and Company
and Alkermes, which combines Lilly's long expertise and leading market position in insulin with Alkermes pulmonary delivery
know-how. That product is scheduled for regulatory submission in 2009.
There was also great speculation surrounding Mannkind Corporation and its Technosphere inhaled insulin candidate, currently
in Phase 3. Mannkind is currently going it alone, and filed with the Securities and Exchange Commission in November to raise
up to $500 million in a public offering to fund the development of Technosphere. The speculation at the time of the Exubera
announcement centered on which major pharmaceutical companies might partner with Mannkind, which is viewed as a necessary
step given the development expense, manufacturing investment, and sales and marketing build-up necessary to launch the product.
The industry buzz suggested that there would be a lot of competition to partner on Technosphere, which has reportedly achieved
good clinical results thus far.
What seemed to be lacking in the coverage of Exubera's withdrawal was an examination of what the market was telling the industry:
was the problem related to Exubera being the first generation of a novel concept and Pfizer's clumsiness in launching it?
Or was it because inhaled insulin is a solution looking for a problem?
There is good reason to examine the latter hypothesis more closely. After all, the biopharmaceutical industry by its nature
tends to be driven more by what science and technology make possible, more than market considerations. This is especially
so in the current environment, where truly novel drugs are proving increasingly difficult to bring to market and new delivery
mechanisms are looked upon as a possible source of salvation. Yet, in the insulin market, competition between Lilly and Novo
Nordisk has already led to major innovations that simplify patient compliance, including pen injector devices with small needles
and implanted insulin pumps. Further, as the incidence of diabetes spreads and insurers face the costs of covering more patients,
it could be tough for higher price therapies to get reimbursed unless they have substantially better patient compliance and
What does all this have to do with outsourcing? Plenty. Contract manufacturers in particular take on big risks when they contract
to provide commercial supply of active ingredients (APIs) or drug product for a drug candidate that is in Phase 2 or Phase
3. The agreement requires them to reserve capacity two to five years into the future and maybe even to invest in new manufacturing
capacity to meet projected demand. Take-or-pay provisions may limit some of the downside if the product fails in clinical
trials or doesn't meet sales projections, but the contract manufacturing organization (CMO) still faces significant risk of
lost revenues and profits.
In such a risky environment, exhaustive due diligence on the client's prospects for clinical and commercial success would
seem to be called for, but the hype surrounding a new drug candidate can make that difficult, especially in the biopharmaceutical
world. The biopharmaceutical industry's focus on technology and deal-making can envelope a new candidate and obscure or overwhelm
the scientific and market realities that it faces. A candidate can be considered a sure thing while still in clinical trials
and facing multiple competitors already on the market. In the case of Exubera, component suppliers Bespak and West Pharmaceutical
Services appeared blind-sided by the Pfizer's decision to pull the product, even though there was plenty of evidence that
the market was not accepting it.